SMILES ACROSS AMERICA DENTAL SEALANT PROGRAM

School Year 2017 -2018 (October 1, 2017 – June 30, 2018)
The West Virginia Oral Health Coalition is pleased to announce that we are again partnering with Oral Health
America focusing on improving children’s oral health in West Virginia. Oral Health America’s “Smiles Across
America” program has generously donated $10,000 to support school-based dental programs, private dentists, and
programs working in collaboration to provide dental sealants to the children of West Virginia.
The funding will go to offset the costs of providing preventive care (specifically sealants) to those uninsured or
underinsured children throughout the state. Eligible Children include:
(1) Those who do not have private dental insurance
(2) Those who have private dental insurance but it doesn’t cover sealants
(3) Those who are not eligible to receive Medicaid/CHIP assistance.
The funding in its entirety will be used to cover the services highlighted below. Reimbursement for services will
only be available until funding is depleted. Once the grant funds are exhausted, participating providers will be
notified immediately. Providers must agree to accept the reduced rate for those covered services and must work
with the child’s family to assure necessary additional treatment is provided. Provider must also agree to serve as
the dental home or work to establish a dental home for the child. Providers may only submit reimbursement for
those services NOT covered by another program or insurance provider. Providers will be responsible for verifying
that the child is not eligible for other coverage such as CHIP/Medicaid. Providers must also bill other insurance or
programs for those children with pre-existing coverage. This program is not intended to be a budget supplement.
Covered services along with rates and restrictions are listed below:
Dental Sealants ADA Code D1351 per Tooth $30 (permanent molars only, covered one time a year per student per
tooth)
The following codes can ONLY be billed in conjunction with sealant placement:
Child Prophylaxis ADA Code D1120 $40
Bitewing x-rays ADA Code D0272 $20
Fluoride Varnish Treatment ADA Code D1206 $20
In submitting for reimbursement the provider is agreeing to the terms listed above. Checks will be issued on a
monthly basis until funds are depleted and providers are encouraged to submit claims in a timely fashion. To
receive reimbursement, a copy of the attached invoice along with the ADA billing form will need to be submitted
to:
Gina Sharps, WVOHC Coordinator
All invoices should be emailed to: wvoralhealthcoalition@gmail.com
Please direct any questions or concerns to Gina Sharps at wvoralhealthcoalition@gmail.com or 304-276-0572